Episode 137 | Fasting Before Chemo: What Every Cancer Patient Needs to Know

Dr. Katie Deming: [00:00:00] What if the most powerful thing you could do before your next chemotherapy treatment was nothing. No food, just water and science to back it up. Welcome to Born To Heal the podcast, helping people with cancer go beyond the western medicine to heal naturally through the ancient power of prolonged water fasting so you can ditch the toxic protocols.

Take control of your health and let your body do what it's designed to do, heal. I'm your host, Dr. Katie Deming. In this episode, you'll discover the biological reason why not eating before chemotherapy may make the treatment more powerful against your cancer, while actually protecting your healthy cells.

You'll also learn what a randomized control trial found when the cancer patients water fasted around their chemotherapy cycles and why the results made oncologists take notice. And finally, the routine medication [00:01:00] given with almost every chemotherapy infusion that may be actively working against your healing and what the research says about eliminating it.

Let's dive in. ~So let me,~ let me start this episode by addressing the elephant in the room. You may have mentioned fasting to your oncologist, and if you did, there's a decent chance you were told some version of you need to keep your strength up, make sure you're eating enough protein. We don't want you losing weight.

So that advice is not malicious. It comes from a real clinical concern about cancer cachexia, the muscle wasting syndrome that affects many patients. It's serious and oncologists are trained to guard against it. But here's what I want you to understand. That advice is based in an incomplete picture of what fasting actually does to the body, and it's leaving patients without information that could meaningfully change their treatment experience for the better.

The Science on Fasting and chemotherapy has been building for over a decade. [00:02:00] It's published in journals like Science, translational Medicine, nature Communications and Aging, and it comes out of institutions like University of Southern California, the University of Tennessee Medical Center, and Leiden University in the Netherlands.

This is not fringe research. This is peer reviewed science, and yet it almost never comes up in oncology treatment planning conversations, and that's what we're fixing today. So let's get into the biology first, because once you understand the mechanism, everything else makes sense. So to understand why fasting and chemotherapy work better together, you need to understand one concept, and it's called differential stress resistance.

And I want you to really sit with that term because if you understand the idea and the concept behind differential stress resistance. You'll understand the rest of this, and it is the foundation of everything we're going to discuss today. So here's the problem that [00:03:00] chemotherapy has always had.

Chemotherapy is essentially a poison, and the reason we use it is that cancer cells, which divide more rapidly than other cells in the body. That's definition of cancer. It's dividing more rapidly than other cells. they are more, when the cells are dividing more rapidly, they are more vulnerable to that poison because they're dividing and they take up the, nutrients more readily.

Okay? So they are more vulnerable to the poison than the normal cells. But more vulnerable does not mean. Only vulnerable, right? The chemo still damages some healthy tissue, and that's why you lose your hair. That's why you feel nauseated. That's why your immune system takes a hit. The drug cannot tell the difference between a cancer cell and the lining of your stomach, okay?

It's just taking up the poison more rapidly because it's dividing more rapidly. But differential stress resistance or DSR is the mechanism by which fasting creates a [00:04:00] distinction between healthy cells versus cancer cells. And here's how it works when you stop eating, so you fast for 24, 48, 72 hours, something remarkable happens in your healthy cells.

Your healthy cells detect the drop in blood glucose, right? 'cause you're not eating. So your blood glucose is going to naturally go down. And it also detects a drop in hormone called IGF one or insulin-like growth factor. And they either your cells respond to these decreases in blood glucose and IGF one by switching into what research call a protected mode.

They slow down growth. They shift their energy toward repair and maintenance. ~They become significant. Me, excuse me,~ they become significantly more resistant to toxic stress. So think of it like your healthy cells putting on armor right before going to battle. ~Okay. Cancer cells cannot do the same thing.~

~Their growth signals are what we call constitutively active. I'm not gonna just get rid of that, Marvin. So cancer cells cannot do the same thing. Cancer cells are hardwired on. They're driven by mutations that keep pushing the accelerator regardless of what the metabolic environment is telling them to do.~

~So when fasting drops, I'm actually gonna. Um, start that over. So where I said cancer cells cannot do the same thing, I'm gonna start there again. ~[00:05:00] So, cancer cells cannot do the same thing. They are ~hired~ hardwired on, and that means they keep pushing the accelerator regardless of what the metabolic environment is telling them to do.

When fasting drops your glucose and your IGF one in the bloodstream, your healthy cells listen and adapt, but cancer cells can't follow and they stay exposed and they continue to divide as they have been. ~So this was first described in research by Dr. Vulture Longo, and colleagues at USC published in the journal cell cycle in 2010.~

~They showed that short term starvation causes a rapid switch of cells to a protected mode capable of protecting the cells in mice, um, from various toxins including chemotherapy. So while the cancer cells driven by those, you know, active growth signals remain vulnerable. The normal cells. Okay, I'm gonna go back actually.~

~So to the line of this was first described by Walter Longo, sorry. Um, Marvin, I'm using a script. I like, I put this stuff together and then I. I shouldn't, I'm, maybe I shouldn't do this. Like I should just have it bullet pointed, but anyway, here we go. Um, so this was first described by research. ~This was first described in research by Dr.

Volter Longo and colleagues at USC. Published in the journal cell cycle in 2010, and what they found was short termed. Short term starvation causes a rapid switch of cells to a protected mode capable of protecting mammalian cells and mice from various toxins including chemotherapy. While the cancer cells driven by those constituently active growth cycles remain vulnerable to the poison or the [00:06:00] chemotherapy.

So the core thesis in this is fasting makes your healthy cells more resistant or resilient to chemotherapy At the exact same moment, it leaves your cancer cells more exposed. ~It potentially widens what we call the therapeutic window, the gap between the dose that kills something and the dose that re causes.~

~Let me just say that one more time. ~It potentially widens what we call the therapeutic window. The therapeutic window is the gap between the dose that kills the cancer and the dose that harms the patient or your normal cells, right? We want a nice big therapeutic window where your cancer cells are killed at a relatively low dose and your normal cells will not be affected to a much higher dose.

That is a larger therapeutic window, and what fasting does is it gives us a bigger therapeutic window by making the cancer cells vulnerable while protecting the normal cells. So now let's look at what happened when researchers tested this in the lab, because the [00:07:00] mechanism is one thing and the experimental data is another.

So. ~In 2012, Dr. Shein Shang Shein. Okay. In 2012, Dr. Shein Lee and Dr. Longo's team published a landmark study in science, translational science translational medicine, one of the most respected translational research journals in medicine. I don't like that part. I'm gonna say that again. In 2012, Dr. Shang, Dr.~

~In 2012, Dr. Shagan Lee and Dr. Longo's team published a landmark study in science plan study in science translational medicine. They tested.~

~I'm gonna say that one more time.~ In 2012, Dr. Shagan Lee and Dr. Longo's team published a landmark study in science translational medicine. They tested short-term starvation against 17 different cancer lines in the lab and multiple mouse tumor models. The result was that 15 of the 17 cancer cell lines were sensitized to chemotherapy by short term starvation.

Meaning fasting made the chemo more effective against nearly every cancer type they tested. And when they looked at the mice with actual tumors, fasting cycles alone, no chemotherapy were as effective as chemotherapy drugs in slowing tumor progression in five out of the eight cancer types. But the most striking finding was what happened when fasting and chemotherapy were combined. When the two were used together, they produced a 20 fold synergistic increase in DNA damage in cancer [00:08:00] cells 20 times.

~That's not additive. That's mul multiple. I'm just stop it after 20 times. ~Fasting and chemotherapy doing something together that neither can accomplish alone. And critically, these changes were not observed in normal tissues. The protective effect in healthy cells held up. The vulnerability in cancer cells increased.

The cancers ~were~ where the combination showed the strongest effectiveness included melanoma glioma, which is a type of breast brain cancer, breast cancer, and neuroblastoma. This work was published in Science of Translational Medicine in 2012. So now I wanna be upfront about something before we move to the human data.

These are mouse and cell line studies. We cannot assume that humans will respond identically because ~bio~ biology is complex. So translation from animal to models to humans is not guaranteed. But as you're about to hear about the human data [00:09:00] points in exactly the same direction, and I think this is important, is that we're looking at.

Okay. You know, the mouse model just gives us that model and like some data to suggest that this may work in humans, but the question is, does it really work in humans? And so this data, um, in 2009, Dr. Fernando Softy and Dr. Longo published the first look at fasting alongside chemotherapy in actual human patients.

And this was a case series, so. 10 patients who had entirely on their own initiative decided to fast before and after chemotherapy cycles. They hadn't been told to do this by their doctors. They had read the research and made their own choice to do this. So this is not a randomized trial. This is a case report of looking at.

People who chose to fast on their own around their chemotherapy, right? So it's not controlled,~ um,~ in the ways that a randomized trial would be, but ~these patients had a range of different cancer types. They, and were receiving different chemotherapy drugs. So the researchers tracked their experience and graded their side effects and using the National Cancer Institute Scale and, um, basically, um, let me just say that again. So~ these patients had a range of different cancer types and were receiving different chemotherapy drugs, [00:10:00] and the researchers tracked their experience and graded their side effects using the na, the Standard National Cancer Institute Scale. And that's the common terminology criteria for adverse events.

But here's what they found. These patients fasted anywhere from 48 to 140 hours before chemotherapy and up to 56 hours after and across all 10 patients. The only side effect attributed to the fasting itself were hunger and lightheadedness. No serious adverse events from the fasting. Of the 10 patients, six had received chemotherapy both with and without fasting, meaning that they had had a direct comparison within their own bodies.

Some of their chemotherapy cycles were were fasted and other cycles were not. And all six of those patients reported a reduction in fatigue. Weakness, gastrointestinal side effects during the cycles when they fasted compared to the cycles when they [00:11:00] didn't, so they had fewer side effects. So let me give you one specific patient example from this paper.

Um, during her five first five chemotherapy cycles without fasting, she experienced severe weakness and fatigue that limited any physical activity after each treatment. And in her sixth and fin nurse. Spinal cycle. The one where she fasted. And actually this is important to realize because with chemotherapy, the side effects, um, they get worse, which e with each cycle, so they're cumulative.

So you have a cumulative effect that you're. Side effects from your sixth cycle should be worse than the side effects of the first or the second or the third, or the fourth or the fifth, because basically now you have cumulative, cumulative toxicity that's billed up. Okay, but this woman, so the first five cycles, she did not fast.

In her sixth and final cycle, the one where she fasted, she reported that her strength returned much more quickly. Three days after [00:12:00] her chemotherapy infusion, she was able to walk three miles. And in previous cycles without fasting, she had been largely unable to move and was really just like laying around in sedentary after her chemotherapy cycles.

And so this, you know, and this is what they saw in these different,~ um,~ people who used fasting for a few of the cycles or one cycle and not for the others, they, their comparison was that they had fewer side effects, they recovered faster. And here's the critical piece where tumor progression could be assessed in these patients.

So not everyone had a, you know, measurable tumor that you could measure on scans or, or measure,~ um,~ physically. Um, but in. The patients where tumor progression could be assessed, fasting did not prevent the chemotherapy from working. The cancer treatment was still effective. The fasting appeared to protect the patient without protecting the tumor, and I think that's important.

Whenever we're talking about studies that you're [00:13:00] wanting to use alongside a conventional treatment like chemotherapy, you wanna make sure that is not going to negate the therapy. So like you don't wanna give something that's going to make the treatment less effective because then you're basically exposing yourself to the side effects without getting that benefit.

Okay. So. One of the things that I wanna note about this study is that these patients were completely unsupervised. They were fasting between 48 and 140 hours before chemo on their own without anyone monitoring their blood glucose, ketone levels, electrolytes, or vital signs, and. This still worked. It wasn't like it had to be done perfectly.

So, ~um, ~of course there's actually like, ~um, ~right and wrong ways to do this and, and it is helpful to get guidance, but just it's interesting that all of these people got benefit even if they weren't really,~ um,~ you know, doing the fasting and in the best way possible. So, um, it tells you something about the robustness of the mechanism of fasting.

Um, and it also raises the question of like, [00:14:00] if that's possible unsupervised, what becomes possible when you have proper clinical oversight and recommendations around fasting that will help you get the best results possible, right? So this is just people doing this not really knowing, um, how to do it. So.

Next. What I wanna go over is the randomized controlled trial. So this, now we're moving into the gold standard of clinical evidence, a randomized controlled trial in 2020. Dr. Courtney Redinger and colleagues at the University of Tennessee Medical Center published a randomized controlled trial of water fasting around chemotherapy in women with gynecologic cancers.

And this was published in gynecologic oncology. So here's the study designed 20 women with ovarian and uterine or cervical cancer. The more majority of them with stage three or four were randomized to either fast or not fast on chemotherapy. So I just wanna simplify that they had 20 women, either ovarian, uterine, or endometrial [00:15:00] or cervical cancer.

Okay, so 20 women with some kind of gynecologic cancer, and most of them had stage three or four disease, which means quite advanced disease. And they were randomized to either fast or not fast around their chemotherapy cycles. And the fasting group maintained a water only fast for 24 hours before and 24 hours after each chemotherapy cycle for a total of 48 hours of fasting.

Right. They fasted 24 hours before the chemo, then they got the chemo and then they fasted for 24 hours,~ um,~ afterwards. And 90% of the participants were receiving a platinum taxane doublet chemotherapy regimen. So basically a platinum and taxane,~ um,~ combination, which is one of the more intensive chemotherapy regimens used in gynecologic oncology.

And actually quite common. So this is one that a lot of people,~ um,~ you know, will,~ uh,~ see. ~So before I get you the results, I wanna explain why the primary outcome they measured was dose reductions and treatment delays and, and so, okay, I wanna read this one more time. ~So now before I give you the results, I wanna explain why the primary outcome they [00:16:00] measured dose reductions and treatment delays is so clinically significant.

So dose reductions happen when a patient's body is struggling to tolerate a treatment. The toxicity is too high, the blood counts are too low. The oncologist has forced the pull back, um, on the drug with every dose and every dose reduction is a compromise. It means every dose reduction is,~ um,~ giving you less than what they know to be deemed optimal for that type of cancer.

So less chemotherapy is reaching your cancer. And from a treatment standpoint, this. Like is important in oncology. So in oncology, they wanna make sure you're getting the full dose that you can get. Now you may argue, you're like, wouldn't it be better to get the lowest possible dose? And I absolutely agree with this, but I'm just speaking from the standpoint of, with these regimens that the, the goal is to give you the full dose of that regimen so that you can get the best, ~um.~

Benefit because [00:17:00] one of the things with cancer treatments, and and that is important to understand, is that you need a certain dose, like I was describing, the ~um, ~the treatment window. The therapeutic window. This, this applies in this category right here too, is that with, ~um. ~Treatment, you need a certain dose in order to get the,~ um,~ benefit to the tumor, right?

But your goal is to do the lowest possible dose while, you know, still getting enough to kill the tumor, right? This is the research in clinical oncology. And so in the oncologist, what they're looking at is like, this was the lowest dose that was, you know, found to be, Effective for this type of cancer.

And so the oncologist is gonna wanna get you as close to that dose as possible. So I wanna explain some of these terms so you can understand like a lot of people just get upset and they're like, oh, the call oncologist just wanna poison me. And the truth is I, no, I don't think that that's true. I think that they definitely, [00:18:00] chemotherapy can be toxic, but what they're trying to do is they're trying to maximize the benefit that you get from that treatment.

Looking at the data and the data basically gives them a threshold dose that they're trying to get to. Okay, so I just wanted to explain that before I came back. But the results in this study,~ um,~ in the fasting group, 8.3% of chemotherapy cycles required a dose reduction in or treatment delay. And in the co control group who ate normally 13.3% of the cycles required a dose reduction or delay.

Okay, so 8.3% versus 13.3%. The fasting group had zero unplanned hospital admissions, so there were no hospital admissions that hadn't been planned for the chemotherapy cycle in the fasting group, and the control group had two. And these numbers are small. These are 20 patients total. So there was 10 in the fasted group and 10 in the non fasted group.

So of the 10 in the fasted group, none of them were hospitalized in the [00:19:00] non-fasting group, two of them, so it's 20% of them were hospitalized. The mean platelet counts, which reflect how well the bone marrow was tolerated, the chemotherapy were significantly higher in the fasting group. And here's the piece that directly addresses the biggest objection around fasting.

So fasting patients did not lose significantly more weight than the control group. Like this is the big thing that everyone's worried about is, oh, you can't lose weight. ~Um, ~so this was a population of stage three and four cancer patients, a group already at elevated risk of, you know, losing weight in cachexia and the water fast.

Did not drive additional weight loss. And this is something that I see in my practice. So I,~ um,~ help guide people through prolonged water fast. So for chemo, but also, um, can do it in like. Longer, like 30 to 40 days of fasting. And one of the things that I was really worried about when I first started doing this is about muscle loss and lean [00:20:00] body mass loss, because that's one of the things that you know is a big objection to fasting.

But the truth is, what's interesting is your body secretes growth hormone after. 24 to 36 hours into, um, water fasting. And so what happens is if you are doing pure water fasting, that growth hormone protects your lean body mass. And I now have been, you know, monitoring patients for clients for this and see that there body lean, body mass, actually.

Maintains during a fast, and this is related to growth hormone. So this study supports that, that,~ um,~ that they did not lose weight, more weight than the people, the,~ um,~ patients who did not fast. So the third human study I wanna walk you through, contains findings I consider. Quite revolutionary. ~Um, ~and it directly connects to something that almost never gets discussed in oncology treatment conversations.

And that is the role of steroids in chemotherapy [00:21:00] and why they may be really working against you. Like actually if there's one drug in that's given an oncology, that I would say is. Dangerous and you know, makes people feel really bad and is definitely not good for cancer if you're approaching cancer from a metabolic standpoint.

And that is steroids. So in this study in 2020, Dru and colleagues published the results of the direct trial in Nature Communications, and this was a randomized phase two trial of 131 patients, all with her two new negative. Stage two and three breast cancer receiving neoadjuvant chemotherapy and neoadjuvant just means they were having chemotherapy before surgery with the intention to shrink the tumor.

~Okay, so all of these women, 131 of them were randomized. Um. Or sorry, before we get to the randomization.~ They were 131 patients with her two new negative stage two or three breast cancer receiving neoadjuvant chemotherapy, and the patients were randomized to either follow a fasting mimicking diet for three days [00:22:00] before and during each chemotherapy cycle, or to eat their regular diet.

And the fasting mimicking diet is a severely calorie restricted diet around 600 calories a day, designed to put the body into a similar metabolic state as fasting with low glucose, low IGF one, elevated ketones, and therefore activating,~ um,~ the DSR. So here's the detail that I want you to focus on. The fasting mimicking diet had dexamethasone omitted from their protocol and dexamethasone is the steroid given with chemotherapy routinely, almost reflexively in standard oncology practice.

And it's given to prevent nausea and allergic reactions to the chemotherapy. So it does have, um. Benefit, but it's also a potent driver of elevated blood sugar. So basically steroids are going to raise your blood sugars and,~ um,~ an elevated blood sugar as we discussed throughout this [00:23:00] podcast is one of the primary signals that drives cancer cell growth.

So every time a patient receives dexamethasone with their chemo, their blood glucose spikes, that is the exact opposite of what we are trying to achieve metabolically. So I just wanna call that out, that ~glucose or, um,~ steroids, specifically Dexamethasone, prednisone is another one that are given with chemotherapy.

Raise your blood sugar, giving us the exact opposite effect of what we want, which is to lower,~ um,~ blood sugar and lower IGF one levels. So the fasting group received no dexamethasone and the control re the control group received the standard of care chemotherapy plus steroids. So what happened in this study?

So there was no difference in toxicity between the two groups. The fasting patients without their steroids tolerated chemotherapy just as well as the patients who received can standard of care with the steroids and their body didn't need the [00:24:00] dexamethasone. The fasting state appeared to provide equivalent protection.

Okay, so I wanna like circle back on this, right? So standard of care, chemotherapy causes nausea, causes, allergic reactions causes these, you know, bad reactions that the doctors are trying to mitigate with the steroids. So they give steroids before the chemotherapy so that you can reduce the toxic side effects.

But those steroids. Basically cause all the problems in the body that are related to cancer and metabolic dysfunction, which is elevated blood glucose and elevated IGF one. So basically the steroid, even though it's helping reduce the side effects of the chemotherapy, it's actually potentially worsening the underlying problem that we're trying to.

We should be addressing with cancer. I wouldn't say Western Medicine is trying to address that 'cause I think that they are approaching it from a totally different lens. But, the steroids basically [00:25:00] help but then worsen the underlying problem. And so what fasting does is fasting. Reduces blood glucose, it reduces IGF one, which is bringing us in the right direction metabolically.

And then those effects basically protect the cell and give us the same low side effects as if you had had the steroid, but without all the toxicity associated with that. But the tumor response data, there's like tumor response data in addition to the steroid data from this trial. And the fasting mimicking diet group had more than three times higher odds of achieving a complete or partial radiologic tumor response, which means they had a three times higher chance of their cancer shrinking or going away when they fasted.

So in per protocol analysis, patients who followed the fasting diet consistently were over four times more likely to achieve what's called a miller in pain. Four or five. [00:26:00] Pathologic response, meaning 90 to a hundred percent tumor cell loss at surgery. And the fasting group had significantly less chemotherapy induced DNA damage to their T lymphocytes, their immune cells.

So this is suggesting that the healthy immune tissue was also being protected by the fasted state. ~So I wanna talk to you directly about this steroid question for a moment, because there is something you may be able to act on. This is something you may be able to act on if you're receiving chemotherapy and you're also, um, let me actually start this over.~

~Okay.~ I wanna talk directly about the steroid question for a moment because this is something you may be able to act on. If you are receiving chemotherapy and you're also considering fasting around your treatment, it is worth having a direct conversation with your oncologist. What is the absolute minimum dose of steroids that we need to use?

Can we reduce it at my next cycle? If I do well with the first cycle, can we reduce it at the second cycle? Can we keep reducing it until we see the lowest dose that I need to take in order to, you know, ~uh, ~protect from the side effects? That is a great question to ask your oncologist because this data supports [00:27:00] that.

That you may not need steroids at all, but if you could even just cut it down in half or by three quarters, that would, you will feel a lot better 'cause steroids, in addition to raising your blood glucose and your IGF one, they make you feel bad, they make you feel agitated, they make you wanna eat everything in sight.

~Um,~ they disrupt your sleep. So if we can avoid them, you're gonna feel a lot better for that. So most oncologists won't volunteer this conversation, so you may need to initiate it and, you know, use this data. ~Um, ~you can cite this study with ~Redinger, um, in 2020, oh, sorry, no, this one is, sorry, this one is, um, 2020 is~ Deru, ~um,~ and colleagues in ~Tri~ Nature Communications.

~So.~

~Okay, ~so before we talk about what this looks like in practice, I wanna quickly address radiation. So I am a radiation oncologist by background, and the fasting data holds up in radiation. I'm not gonna go into a full, in depth, ~um. ~Summary here of data around fasting and radiation. I'll do that in a separate episode, but I'd like to just call your attention to that.

This doesn't just work for chemotherapy. This also works for [00:28:00] radiation, and so this study is in from 2012, SAF D and colleagues published a study in PLOS one. Following that fasting enhance the response of glioma, a type of brain tumor to both chemotherapy and radiation. The differential stress resistance, which we've been talking about this, the DSR mechanism applies not only to cytotoxic drugs, but to radiation induced DNA damage as well.

And this just means that it also works for radiation, right? So the healthy brain cells are protected by the fasted state and the tumor cells with their ~constitutively~ constitutively. Active growth cycles remain sensitized. To the damage caused by both the drugs and the radiation. So this is a way that the tumor cells are preferentially able to still have the effect of the treatment while protecting the normal cells from those toxic side effects.

So if you're receiving radiation as part of your treatment [00:29:00] plan, whether conventional, daily radiation or shorter, a shorter stereotactic course, ~um,~ the biology here applies to you too, and fasting around radiation treatment, um, may be worth discussing. So, and like I said, I'm gonna do a separate episode so you can have all the information there, but definitely if I don't have that episode up yet,~ um,~ it's definitely something I would talk to your radiation oncologist about.

Okay, so I said at the beginning of this episode that you deserve the whole picture. So let me be direct with you about what we don't know. So the most powerful mechanistic data, the 20 fold synergistic, DNA damage increase of those 15 to 17 cancer cell lines is from mice and self cultures, right? We talked about this in the beginning.

Human biology is more complex, so translational. From, or translation from animal models is not guaranteed, right? But then we have the randomized trials in humans, and these are small studies, right? So the redinger, random randomized control [00:30:00] trial had 20 patients. The direct trial had 131. These are meaningful signals, but not definitive ~verdicts.~

Verdicts, right? So larger, what you're gonna hear, you know, from the doctor is larger. Trials are needed and some larger trials are underway. ~Um, ~and those results are gonna be great. But what the doctors are gonna say is, we need more randomized data. And so that may be why they're not bringing this up, but I wanna show you that we do have some of this data.

That's enough to say this is a signal. And recognizing that water fasting is not something that is. Particularly lucrative and not something that is going to be funded by pharmaceutical trials. So it just, it, the literature is going to be more limited because of that. ~Um, so there is also an important biological caveat.~

~So in 2009, study published in Nature by Kani and Sabatini found that tumors with P one. Oh, actually, so I'm gonna, don't, don't, Marvin, just get rid of that. Where I was supposed to say there was an important caveat. I'm not to do that. Um, so at this point, I imagine you're asking the question I hear from patients all the time. Sorry, I'm gonna go back.~ At this point, I imagine you're asking the question I hear all the time, this all makes sense. The research is compelling, but what does it look like for me? Like my specific regimen, my specific body, my specific cancer, my specific situation?

And [00:31:00] that's exactly the right question to be asking because the honest answer is that it depends. So how you fast run your camera therapy, it depends on how often you're receiving treatment. Is it every week? Is it every other week? Is it on day one and day 14 and day 28? Or, you know. Does it have, what is the, schedule and is it chemotherapy?

Is it immunotherapy or a combination? And it also depends on your current weight and your nutritional status. Your tumor type. ~Um, ~there's a lot that goes into this, so it's not like you can just say, oh, this is gonna be exactly like this for you. But the good news is that there are definitely general principles, right?

But there's no single protocol that works for every person in every treatment situation. And anyone who tells you otherwise isn't ~giving you, ~giving you like the full picture of,~ um,~ fasting around. ~Um. ~Chemotherapy, conventional therapy, immunotherapy. What I can tell you is that the research we reviewed today is not theoretical [00:32:00] and it is actionable.

People are doing this right now and they're tolerating their treatment better because of it. But it needs to be done thoughtfully with guidance and with proper monitoring. So you and your clinical team have real time information about how your body is responding to this. So the difference between doing this alone and doing it with support is the difference between unsupervised patients in the 2009 case series, right?

Where they were just like going it alone. They were just doing their own thing. They did get benefit, right? They got results, but they had no safety net. So there's a difference between that and a personalized plan built around your specific treatment protocol, your labs, and your goals. So, and that is exactly what I would love to see all of you guys build because it's, it's not that complicated to do this.

You just need to understand, um, some of the principles and, ~um. ~You know, I'm gonna tell you how to do that in a moment, but what I wanna do is I wanna summarize what we've learned here. So [00:33:00] here are the key points that we cover today. Fasting activates a mechanism called differential stress resistance, or DSR.

And your healthy cells shift into a protected mode before chemotherapy hits. While cancer cells locked into growth mode by their own mutations, can't adapt and are left more exposed to drugs. You also learned that there are human trials, including a randomized control trial showing that cancer patients who water fasted around chemotherapy had fewer dose reductions, fewer hospitalizations and better tumor response without losing additional weight.

And finally you learned that steroids routinely given with chemotherapy spikes, blood sugar, and maybe undermining your metabolic defenses. And one landmark trial showed that fasting patients who skipped it entirely did just as well in toxicity, in significantly better in tumor response. So if this episode has you asking, could this apply to [00:34:00] me, I wanna give you a clear next step.

I'm hosting a live workshop called Fasting and Chemotherapy, what the research says and how to do it safely. And I'm going to walk you through the clinical protocols, real patient examples, and answer your questions live so you can figure out what this would look like in your situation and that you can have a plan that you can take to your doctor and say, this is what I wanna do around my chemotherapy.

And so. That way you know that you have a safe plan. You're, you can tell your doctor what you're doing because I do think it's important to be communicating with your doctor about the other things that you're doing, ~um,~ so that everyone can take the best care of you. And also the other thing is that if you bring this to your doctor and you do better.

Then his other or her other patients, then they're more likely to use fasting themselves. And I would not like to see anything better than having all oncologists recommending fasting around,~ um,~ chemotherapy cycles. So I. This is what I'm gonna teach you guys so that you can develop a [00:35:00] plan and that you can take it back to your oncologist.

~Um, ~and so basically this is a workshop on fasting and chemotherapy. The link to register is gonna be in the show notes. And if you know someone who is currently in treatment, please share this episode with them. The information changes the conversation and. Nobody needs to have more side effects associated with chemotherapy than they need and also more steroids than they need.

So I appreciate you sticking around to the end and um, I look forward to seeing you in the next episode. Take care.